Extravascular lung water in sepsis-associated acute respiratory distress syndrome: Indexing with predicted body weight improves correlation with severity of illness and survival

Charles R. Phillips, Mark Chestnutt, Stephen Smith

Research output: Contribution to journalArticle

143 Citations (Scopus)

Abstract

OBJECTIVES: To determine whether extravascular lung water predicts survival in patients with early acute respiratory distress syndrome, to determine the relationship between extravascular lung water and other markers of lung injury, and to examine if indexing extravascular lung water with predicted body weight (EVLWp) strengthens its discriminative power. DESIGN: Extravascular lung water and other markers of lung injury were measured prospectively in 19 patients with sepsis-induced acute respiratory distress syndrome for 3 days. SETTING: The intensive care units of an academic tertiary referral hospital. MEASUREMENTS AND MAIN RESULTS: Lung injury score, Sequential Organ Failure Assessment score, dead space-tidal volume fraction (Vd/Vt), and EVLWp were all significantly higher on day 1 in nonsurvivors compared with survivors (lung injury score, 2.8 ± 0.34 vs. 1.9 ± 0.50; p = .004) (Sequential Organ Failure Assessment score, 13 ± 3.4 vs. 7.7 ± 0.8; p = .006) (Vd/Vt, 0.68 ± 0.07 vs. 0.58 ± 0.07; p = .009) (EVLWp, 20.6 ± 4.6 vs. 11.6 ± 1.9 mL/kg; p = .002). EVLWp correlated with Sequential Organ Failure Assessment score, lung injury score, Vd/Vt, and Pao2/Fio2. The receiver operator characteristic curve analysis indicated that EVLWp, Vd/Vt, and extravascular lung water (p = .0005, .009, and .013, respectively) but not Pao2/Fio2 (p = .311) discriminate between survivors and nonsurvivors. Three-day average EVLWp >16 mL/kg predicted in-hospital mortality with 100% specificity and 86% sensitivity. CONCLUSIONS: Increased extravascular lung water is a feature of early acute respiratory distress syndrome and predicts survival. Indexing extravascular lung water to predicted body weight, instead of actual body weight, improves the predictive value of extravascular lung water for survival and correlation with markers of disease severity.

Original languageEnglish (US)
Pages (from-to)69-73
Number of pages5
JournalCritical Care Medicine
Volume36
Issue number1
DOIs
StatePublished - Jan 2008

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Extravascular Lung Water
Adult Respiratory Distress Syndrome
Sepsis
Body Weight
Lung Injury
Survival
Organ Dysfunction Scores
Survivors
Tidal Volume
Hospital Mortality
Tertiary Care Centers
Intensive Care Units
Sensitivity and Specificity

Keywords

  • Acute respiratory distress syndrome
  • Extravascular lung water
  • Physiologic deadspace fraction
  • Pulmonary edema
  • Sepsis
  • Transpulmonary thermodilution

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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title = "Extravascular lung water in sepsis-associated acute respiratory distress syndrome: Indexing with predicted body weight improves correlation with severity of illness and survival",
abstract = "OBJECTIVES: To determine whether extravascular lung water predicts survival in patients with early acute respiratory distress syndrome, to determine the relationship between extravascular lung water and other markers of lung injury, and to examine if indexing extravascular lung water with predicted body weight (EVLWp) strengthens its discriminative power. DESIGN: Extravascular lung water and other markers of lung injury were measured prospectively in 19 patients with sepsis-induced acute respiratory distress syndrome for 3 days. SETTING: The intensive care units of an academic tertiary referral hospital. MEASUREMENTS AND MAIN RESULTS: Lung injury score, Sequential Organ Failure Assessment score, dead space-tidal volume fraction (Vd/Vt), and EVLWp were all significantly higher on day 1 in nonsurvivors compared with survivors (lung injury score, 2.8 ± 0.34 vs. 1.9 ± 0.50; p = .004) (Sequential Organ Failure Assessment score, 13 ± 3.4 vs. 7.7 ± 0.8; p = .006) (Vd/Vt, 0.68 ± 0.07 vs. 0.58 ± 0.07; p = .009) (EVLWp, 20.6 ± 4.6 vs. 11.6 ± 1.9 mL/kg; p = .002). EVLWp correlated with Sequential Organ Failure Assessment score, lung injury score, Vd/Vt, and Pao2/Fio2. The receiver operator characteristic curve analysis indicated that EVLWp, Vd/Vt, and extravascular lung water (p = .0005, .009, and .013, respectively) but not Pao2/Fio2 (p = .311) discriminate between survivors and nonsurvivors. Three-day average EVLWp >16 mL/kg predicted in-hospital mortality with 100{\%} specificity and 86{\%} sensitivity. CONCLUSIONS: Increased extravascular lung water is a feature of early acute respiratory distress syndrome and predicts survival. Indexing extravascular lung water to predicted body weight, instead of actual body weight, improves the predictive value of extravascular lung water for survival and correlation with markers of disease severity.",
keywords = "Acute respiratory distress syndrome, Extravascular lung water, Physiologic deadspace fraction, Pulmonary edema, Sepsis, Transpulmonary thermodilution",
author = "Phillips, {Charles R.} and Mark Chestnutt and Stephen Smith",
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T2 - Indexing with predicted body weight improves correlation with severity of illness and survival

AU - Phillips, Charles R.

AU - Chestnutt, Mark

AU - Smith, Stephen

PY - 2008/1

Y1 - 2008/1

N2 - OBJECTIVES: To determine whether extravascular lung water predicts survival in patients with early acute respiratory distress syndrome, to determine the relationship between extravascular lung water and other markers of lung injury, and to examine if indexing extravascular lung water with predicted body weight (EVLWp) strengthens its discriminative power. DESIGN: Extravascular lung water and other markers of lung injury were measured prospectively in 19 patients with sepsis-induced acute respiratory distress syndrome for 3 days. SETTING: The intensive care units of an academic tertiary referral hospital. MEASUREMENTS AND MAIN RESULTS: Lung injury score, Sequential Organ Failure Assessment score, dead space-tidal volume fraction (Vd/Vt), and EVLWp were all significantly higher on day 1 in nonsurvivors compared with survivors (lung injury score, 2.8 ± 0.34 vs. 1.9 ± 0.50; p = .004) (Sequential Organ Failure Assessment score, 13 ± 3.4 vs. 7.7 ± 0.8; p = .006) (Vd/Vt, 0.68 ± 0.07 vs. 0.58 ± 0.07; p = .009) (EVLWp, 20.6 ± 4.6 vs. 11.6 ± 1.9 mL/kg; p = .002). EVLWp correlated with Sequential Organ Failure Assessment score, lung injury score, Vd/Vt, and Pao2/Fio2. The receiver operator characteristic curve analysis indicated that EVLWp, Vd/Vt, and extravascular lung water (p = .0005, .009, and .013, respectively) but not Pao2/Fio2 (p = .311) discriminate between survivors and nonsurvivors. Three-day average EVLWp >16 mL/kg predicted in-hospital mortality with 100% specificity and 86% sensitivity. CONCLUSIONS: Increased extravascular lung water is a feature of early acute respiratory distress syndrome and predicts survival. Indexing extravascular lung water to predicted body weight, instead of actual body weight, improves the predictive value of extravascular lung water for survival and correlation with markers of disease severity.

AB - OBJECTIVES: To determine whether extravascular lung water predicts survival in patients with early acute respiratory distress syndrome, to determine the relationship between extravascular lung water and other markers of lung injury, and to examine if indexing extravascular lung water with predicted body weight (EVLWp) strengthens its discriminative power. DESIGN: Extravascular lung water and other markers of lung injury were measured prospectively in 19 patients with sepsis-induced acute respiratory distress syndrome for 3 days. SETTING: The intensive care units of an academic tertiary referral hospital. MEASUREMENTS AND MAIN RESULTS: Lung injury score, Sequential Organ Failure Assessment score, dead space-tidal volume fraction (Vd/Vt), and EVLWp were all significantly higher on day 1 in nonsurvivors compared with survivors (lung injury score, 2.8 ± 0.34 vs. 1.9 ± 0.50; p = .004) (Sequential Organ Failure Assessment score, 13 ± 3.4 vs. 7.7 ± 0.8; p = .006) (Vd/Vt, 0.68 ± 0.07 vs. 0.58 ± 0.07; p = .009) (EVLWp, 20.6 ± 4.6 vs. 11.6 ± 1.9 mL/kg; p = .002). EVLWp correlated with Sequential Organ Failure Assessment score, lung injury score, Vd/Vt, and Pao2/Fio2. The receiver operator characteristic curve analysis indicated that EVLWp, Vd/Vt, and extravascular lung water (p = .0005, .009, and .013, respectively) but not Pao2/Fio2 (p = .311) discriminate between survivors and nonsurvivors. Three-day average EVLWp >16 mL/kg predicted in-hospital mortality with 100% specificity and 86% sensitivity. CONCLUSIONS: Increased extravascular lung water is a feature of early acute respiratory distress syndrome and predicts survival. Indexing extravascular lung water to predicted body weight, instead of actual body weight, improves the predictive value of extravascular lung water for survival and correlation with markers of disease severity.

KW - Acute respiratory distress syndrome

KW - Extravascular lung water

KW - Physiologic deadspace fraction

KW - Pulmonary edema

KW - Sepsis

KW - Transpulmonary thermodilution

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